BHC home - health and medical information for consumers

Health and medical information for consumers, quality assured by the Victorian government (Australia).

23 November, 2009

Home > Fact sheets by category > Diseases and conditions > Kidney and bladder > Kidney > Kidney failure.

Health information

Resources and tools

Healthy eating

Find help

Kidney failure

If you have kidney disease, it does not mean that you will develop kidney failure. One in seven Australian adults aged over 25 years have at least one sign of chronic kidney disease. Only a few people with kidney or urinary problems have long-lasting kidney damage and even fewer have kidney failure.

Kidney failure occurs when the kidneys are no longer able to remove waste from your blood and control the level of fluid in the body. Kidney failure can happen suddenly or gradually. People with kidney failure need dialysis or a transplant to stay alive.

About 52,000 Australians aged 12 to 74 years have severely damaged kidneys. In many cases, the signs of disease aren’t noticed until the kidneys are close to failure. You can lose up to 90 per cent of kidney function before you even feel sick.

Causes of kidney disease
Some of the causes of kidney disease include:

Diabetic nephropathy – even if it is well managed, diabetes can cause kidney damage.
Hypertension – high blood pressure.
Glomerulonephritis – swelling or inflammation of the tiny filtering units (nephrons) in the kidney.
Polycystic kidney disease – an inherited condition that causes hundreds of cysts to form in the kidneys.
Reflux nephropathy – a bladder valve problem allowing urine to flow back into the kidneys causing scarring.
Medications – some drugs such as lithium and cyclosporin can cause kidney failure. Continued misuse of compound analgesic preparations (now banned) was once a common cause of permanent kidney damage. Non-steroidal anti-inflammatory drugs (NSAIDS), taken in normal therapeutic doses, may occasionally cause acute kidney failure.

Chronic kidney disease
Often the development of kidney disease is gradual and kidney function worsens over a number of years. If you permanently lose more than one-third of your kidney function, it is called ‘chronic kidney disease’. Chronic kidney disease can lead to kidney failure. You are more at risk of chronic kidney disease if you:

Have diabetes
Have high blood pressure
Are obese
Are over 50 years of age
Have a family history of kidney disease
Smoke – men who smoke are three times more likely to have reduced kidney function
Are of Aboriginal or Torres Strait Islander descent.

The risk of chronic kidney disease resulting in kidney failure depends on your level of kidney damage. Glomerulonephritis (inflammation of the kidney filters or glomeruli) and diabetes are the main causes of kidney failure in Australia.

If kidney disease is found early, medication combined with diet and lifestyle changes can increase the life of your kidneys.

Acute kidney failure
Acute kidney failure is a sudden loss of kidney function that affects many Australian adults each year. Acute kidney failure can be life threatening and requires immediate treatment.

Many people with acute kidney failure need dialysis while they are waiting for their kidneys to recover. Sometimes treatment is a matter of controlling blood pressure and blood chemistry, while waiting for kidney function to return.

Nearly half of all people diagnosed with acute kidney failure die within three months. Men are two to three times more likely to develop acute kidney failure than women. Most children with acute kidney failure make a full recovery.

Diagnosis methods
If chronic kidney disease is found, tests may be used to find the:

Cause of the kidney damage
Amount of kidney damage
Treatment options.

Tests can include:

Blood tests to establish the estimated glomerular filtration rate (eGFR), which measures how well the kidneys filter the wastes from the blood and is the best measure of kidney function
A blood pressure check
Urine tests for blood, protein, glucose and red or white blood cells
An ultrasound, CT scans, x-rays and other imaging techniques to take pictures of your kidneys
A kidney biopsy, where a needle is used to remove a small piece of kidney tissue for examination under a microscope.

Treatment options
The treatment choices for kidney failure include:

Dialysis
Kidney transplantation
Conservative or no treatment.

Dialysis
Dialysis artificially removes waste from your blood. Dialysis is only needed when the kidneys fail. There are two forms of dialysis – haemodialysis and peritoneal dialysis. About 2,000 Australian adults start dialysis each year and most are aged over 45 years.

Haemodialysis
During haemodialysis a machine acts as an artificial kidney by removing waste and extra fluid from your blood. Blood is pumped from your body through special tubing into the dialysis machine. It then travels through a filter called a dialyser. The dialyser also helps to balance fluid, minerals and chemicals in the blood. Cleansed blood is returned to your body at the same rate at which it is removed.

Haemodialysis needs access to your bloodstream. This is done by the creation of a ‘vascular access’ during surgery. There are three types of access:

An arteriovenous fistula, which is permanent
A prosthetic or artificial graft, which is also permanent
A special catheter, which can be long-term but is usually temporary until a fistula or graft is ready for use.

Important points to consider include:

Haemodialysis can be done at home, at a self-care ‘satellite’ dialysis centre or at a hospital renal unit.
Each haemodialysis treatment takes about 4 to 6 hours and usually takes place about three times per week.
Dietary changes include reducing fluids, limiting dairy food, avoiding salty foods and controlling the amount of potassium you eat.

Peritoneal dialysis
Like haemodialysis, peritoneal dialysis replaces lost kidney function. Instead of cleaning the blood and removing excess fluid externally, peritoneal dialysis occurs inside your body using the peritoneal membrane as a filter.

The peritoneal membrane is a fine layer of tissue that lines your peritoneal cavity, which contains your stomach, liver, spleen and intestines. It has a rich blood supply and is ideal for filtering wastes and extra water from your blood.

Peritoneal dialysis uses an access device called a catheter. A soft tube is put into the peritoneal cavity during an operation. The catheter is about 0.5cm wide and remains in your body until dialysis is no longer needed. One end of the catheter sticks a few centimetres out of your body, so that it can be connected to a bag containing a special fluid. The catheter allows the fluid to enter and leave your peritoneal cavity. Waste and extra fluid move from your blood into the special fluid, which is then drained from the body.

Each time ‘used’ fluid is replaced by fresh fluid, the cycle is called an ‘exchange’. The number of exchanges needed differs from one person to the next.

Two types of peritoneal dialysis
There are two main types of peritoneal dialysis:

Continuous ambulatory peritoneal dialysis (CAPD)
Automated peritoneal dialysis (APD).

Continuous ambulatory peritoneal dialysis (CAPD)
This type of dialysis is usually done four times a day. Each exchange takes about 30 minutes. It can be done almost anywhere, as long as a clean area is available. In between exchanges you are free to go about your daily activities.

A bag of special fluid is connected to your catheter by a short plastic tube. By raising the bag above shoulder level, the fluid flows into your peritoneal cavity. When the bag is empty, it is disconnected. Dialysis begins straight away. After four to six hours, the used fluid is removed by attaching a drainage bag to the catheter and lowering the bag to the floor. Fresh fluid is put back into your body and the cycle continues.

Automated peritoneal dialysis (APD)
During APD a machine called a cycler does the exchanges automatically. Each night your catheter is attached to the cycler. The cycler does four or more exchanges during sleep, controlling the movement of fluid into and out of the peritoneal cavity. During the day the special fluid is usually left in your body so that dialysis can still occur.

Kidney transplants
A kidney transplant is one treatment for kidney failure but it is not a cure. A transplant offers a more active life, and freedom from dialysis and restrictions on fluid and dietary intake. However, your new kidney requires a lifetime of management and care.

Kidney transplants can come from living or deceased donors. The person receiving the kidney is called the recipient and the person giving the kidney is called the donor. Living donors can be relatives as well as partners and close friends. There are now as many live donations as deceased kidney donations.

Deceased donors are people who die suddenly, for example in a car accident. They have often already decided to donate their organs after death. If it is unknown whether the deceased person has consented, their family can make the decision about organ donation.

A transplant from a deceased donor is available to medically suitable patients who have been stabilised on dialysis. If the transplant is from a living donor, the operation can be done when the kidneys are close to failing but before dialysis starts.

A transplant is not always the best option
Not everyone is suitable for a transplant. Sometimes other major medical problems make dialysis a better treatment option. Factors that affect your suitability for a transplant include:

Agreement with the idea of transplantation
General physical health, apart from kidney failure
Willingness to go through with the tests and operation
Willingness to undertake the lifelong medication treatment.

Transplant procedure
During a transplant the donated kidney is placed inside recipient’s pelvis and attached to their blood vessels and urinary tract. Their own kidneys are usually left in place. The operation takes up to three hours. After a successful transplant, the recipient no longer needs dialysis or special diets.

It is important that the blood and tissue of the donor and recipient match as closely as possible, to reduce the risk of problems such as rejection. Rejection is when the recipient’s immune system attacks and tries to destroy the new kidney. Drugs to control the immune system are needed for the rest of a patient’s life to reduce the risk of rejection.

Where to get help

Your doctor
Your local community health centre
Kidney Health Australia Information Line Tel. 1800 4 KIDNEY (543 639), TTY 1800 005 881

Things to remember

Kidney failure can be sudden or gradual.
Kidney failure can be life threatening and requires immediate treatment.
Some kidney conditions are treatable, while others may lead to kidney failure.

You might also be interested in:
Blood pressure (high) - hypertension.
Diabetes and kidney failure.
Haemolytic uraemic syndrome.
Kidney disease - prevention.
Kidney disease - tests.
Kidney disease and cardiovascular risks.
Kidney reflux.
Kidneys - age related problems.
Kidneys - cystic kidney disease.
Kidneys - medullary cystic kidney disease.
Kidneys - medullary sponge kidney.
Kidneys - polycystic kidney disease.
Kidneys explained.
Retroperitoneal fibrosis.

Want to know more?
Go to More information for support groups, related links and references.

This page has been produced in consultation with and approved by:

(Logo links to further information)